I 

116TH CONGRESS 

1ST SESSION H. R. 3029 

To amend title XVIII of the Social Security Act to provide transitional 

coverage and retroactive Medicare part D coverage for certain low-income 

beneficiaries. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 28, 2019 

Mr. OLSON (for himself, Ms. BARRAGA ́N, Mr. MARCHANT, and Mr. LEWIS) 

introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and 

Means, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

transitional coverage and retroactive Medicare part D 

coverage for certain low-income beneficiaries. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Improving Low-Income 

5 Access to Prescription Drugs Act of 2019’’. 


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1 SEC. 2. TRANSITIONAL COVERAGE AND RETROACTIVE 

2 MEDICARE PART D COVERAGE FOR CERTAIN 

3 LOW-INCOME BENEFICIARIES. 

4 Section 1860D–14 of the Social Security Act (42 

5 U.S.C. 1395w–114) is amended— 

6 (1) by redesignating subsection (e) as sub7 section (f); and 

8 (2) by adding after subsection (d) the following 

9 new subsection: 

10 ‘‘(e) LIMITED INCOME NEWLY ELIGIBLE TRANSI11 TION PROGRAM.— 

12 ‘‘(1) IN GENERAL.—The Secretary shall carry 

13 out a program to provide transitional coverage for 

14 covered part D drugs for LI NET eligible individ15 uals in accordance with this subsection. 

16 ‘‘(2) LI NET ELIGIBLE INDIVIDUAL DEFINED.— 

17 For purposes of this subsection, the term ‘LI NET 

18 eligible individual’ means a part D eligible individual 

19 who— 

20 ‘‘(A) is a subsidy eligible individual; and 

21 ‘‘(B) has not yet enrolled in a prescription 

22 drug plan or an MA–PD plan, or, who has so 

23 enrolled, but with respect to whom coverage 

24 under such plan has not yet taken effect. 

25 ‘‘(3) TRANSITIONAL COVERAGE.—For purposes 

26 of this subsection, the term ‘transitional coverage’ 


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1 means with respect to an LI NET eligible indi2 vidual— 

3 ‘‘(A) immediate access to covered part D 

4 drugs at the point of sale during the period 

5 that begins on the first day of the month such 

6 individual is determined to be a subsidy eligible 

7 individual and ends on the date that coverage 

8 under a prescription drug plan or MA–PD plan 

9 takes effect with respect to such individual; and 

10 ‘‘(B) in the case of an LI NET eligible in11 dividual who is a full-benefit dual eligible indi12 vidual (as defined in section 1935(c)(6)) or a 

13 recipient of supplemental security income bene14 fits under title XVI, retroactive coverage (in the 

15 form of reimbursement of the amounts that 

16 would have been paid under this part had such 

17 individual been enrolled in a prescription drug 

18 plan or MA–PD plan) of covered part D drugs 

19 purchased by such individual during the period 

20 that begins on the date that is the later of— 

21 ‘‘(i) the date that such individual was 

22 first eligible for a low-income subsidy 

23 under this part; or 


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1 ‘‘(ii) the date that is 36 months prior 

2 to the date such individual enrolls in a pre3 scription drug plan or MA–PD plan, 

4 and ends on the date that coverage under such 

5 plan takes effect. 

6 ‘‘(4) PROGRAM ADMINISTRATION.— 

7 ‘‘(A) SINGLE POINT OF CONTACT.—The 

8 Secretary shall, to the extent feasible, admin9 ister the program under this subsection through 

10 a contract with a single program administrator. 

11 ‘‘(B) BENEFIT DESIGN.—The Secretary 

12 shall ensure that the transitional coverage pro13 vided to LI NET eligible individuals under this 

14 subsection— 

15 ‘‘(i) provides access to all covered part 

16 D drugs under an open formulary; 

17 ‘‘(ii) permits all pharmacies deter18 mined by the Secretary to be in good 

19 standing to process claims under the pro20 gram; 

21 ‘‘(iii) is consistent with such require22 ments as the Secretary considers necessary 

23 to improve patient safety and ensure ap24 propriate dispensing of medication; and 


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1 ‘‘(iv) meets such other requirements 

2 as the Secretary may establish. 

3 ‘‘(5) RELATIONSHIP TO OTHER PROVISIONS OF

4 THIS TITLE; WAIVER AUTHORITY.— 

5 ‘‘(A) IN GENERAL.—The following provi6 sions shall not apply with respect to the pro7 gram under this subsection: 

8 ‘‘(i) Paragraphs (1) and (3)(B) of sec9 tion 1860D–4(a) (relating to dissemination 

10 of general information; availability of infor11 mation on changes in formulary through 

12 the internet). 

13 ‘‘(ii) Subparagraphs (A) and (B) of 

14 section 1860D–4(b)(3) (relating to require15 ments on development and application of 

16 formularies; formulary development). 

17 ‘‘(iii) Paragraphs (1)(C) and (2) of 

18 section 1860D–4(c) (relating to medication 

19 therapy management program). 

20 ‘‘(B) WAIVER AUTHORITY.—The Secretary 

21 may waive such other requirements of titles XI 

22 and this title as may be necessary to carry out 

23 the purposes of the program established under 

24 this subsection.’’. 

Æ 


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